Sometimes it’s a fall that brings a broken hip and a loss of mobility. Or memory problems that bubble into danger. Or the death of the partner who was relied upon for care.
The need to move to a nursing home, assisted living facility, or another type of care setting often comes suddenly, setting off an abrupt, daunting search. It’s likely something no one ever wanted, but knowing what to look for and what to ask can make a big difference.
Here’s what to do when looking for a long-term care facility:
Start with government ratings
Regulation of assisted living facilities varies greatly from state to state, meaning there’s no centralized standards or source for information. If you’re looking for a nursing home, though, they are monitored by the federal government.
The Centers for Medicare and Medicaid Services maintains records on nursing homes, including data on who owns the facility, how robust its staffing is, and what types of violations it might have been fined for. It assigns homes a star rating, from one to five.
Sam Brooks, director of public policy for the National Consumer Voice for Quality Long-Term Care, says while the star rating “can be notoriously unreliable,” due to its reliance on self-reported data, it can still provide some clues about a home.
“One or two stars, expect it to be bad,” Brooks says.
Ratings can be a resource to rule out the worst options, but not necessarily to find the best. Still, Brooks suggests taking a closer look at four- and five-star facilities and to consider a home’s ownership, too. Nonprofit homes are often better staffed.
You could scour inspection reports and online reviews for clues, too, but eventually you’ll need to make a list of potential candidates and start making visits.
“The data,” Brooks says, “only goes so far.”
Look past the lobby
When visiting a home on your list, be careful not to be too swayed by decorative touches that might be designed to lure you in, like a lobby’s furniture, dangling chandeliers, or vases of flowers.
“When I tour a building, I listen first. Is it loud? Are call bells ringing nonstop?” says Mark Sanchez, CEO of United Hebrew, a nursing home in New Rochelle, N.Y.
After that, Sanchez says, switch your senses. Do you detect an odor? Do you see residents clustered around the nurses’ station, perhaps clamoring for help? Are staffers speaking respectfully to residents? Are they making eye contact? Are they rushed?
“Culture shows up in small moments,” Sanchez says, “and it matters.”
Seeking input from families of current residents can be insightful. Another resource may be your local long-term care ombudsman. Ombudsmen, funded by the federal Older Americans Act and present in every state, investigate long-term care residents’ complaints.
With all the available information on each home, it can be easy to feel like you’re drowning in data. So pay attention to how a place feels, too, and pair that with concrete facts.
When Jennifer Fink was making the “stressful, grief-inducing, hard, and scary” decision on what memory care community was right for her mother, she didn’t consult state databases or Google ratings. She went with her gut reaction and luckily, it was right.
“Trust your gut. Keep top of mind that the salesperson wants your loved one’s money,” says Fink, of Auburn, Calif. “If it’s giving you the ‘ick,’ then move on.”
Staffing matters most
More than any other single thing, experts on long-term care stress that a facility’s staffing is most important. That means both the quality of the care you witness workers giving residents during your visit and the average staffing levels shown in the reported data.
A home providing an average of three hours of nursing care to each resident each day may not look all that different on paper from one providing three-and-a-half hours. But those minutes matter dearly, meaning the difference between a person getting a shower, having help at mealtime, or being discovered if they’ve fallen.
During a visit, pay attention to how quickly call bells are answered and whether it seems like residents are engaged in activities. Ask staff how long they’ve worked there. A home that holds on to its workers for years may offer your loved one more continuity.
Evan Farr, an elder law attorney in Lorton, Va., who wrote The Nursing Home Survival Guide, says visiting a facility at night or on the weekend can be particularly revealing.
“These are the times when staffing is reduced and the true operation of the facility becomes apparent,” Farr says. “It is entirely possible to have a five-star rated facility that is woefully understaffed from 5 p.m. Friday until 8 a.m. Monday morning.”
Keep a long-range view
When faced with an urgent decision, it can be difficult to focus on anything beyond the factors in front of you. But it’s important to choose a home with a long-range view.
At the start, many long-term care residents are able to pay for the cost of their bill. But what happens if their money runs out? If it’s a nursing home that accepts Medicaid, how many beds are allocated to such residents? Would your loved one get that slot? If it’s an assisted living facility, do they even accept people on Medicaid?
Assisted living facilities often have complicated billing structures that require a bevy of questions to understand. Ask how costs may change as a person’s needs increase. Some places tack on separate charges for tasks like helping a person to the bathroom.
“Four-thousand dollars a month can become $8,000 overnight,” says Geoff Hoatson, founder of the elder law practice Family First Firm in Winter Park, Florida.
Another fact of long-term care that few understand is how often facilities seek to remove residents seen as undesirable, often due to a change in their financial circumstances or in their health. Dementia patients in particular — with challenging care needs and symptoms that can sometimes bring aggression — are targeted with orders to leave.
“Ask specifically what conditions would require transfer,” Hoatson says.
